Accuracy and Precision of the Signs and Symptoms of Streptococcal Pharyngitis in Children: A Systematic Review

• Published in: The Journal of pediatrics Vol. 160; no. 3; pp. 487 - 493.e3
• Main Authors: Shaikh, Nader, MD, MPH, Swaminathan, Nithya, MD, Hooper, Emma G., BA
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Elsevier Inc 01-03-2012; Elsevier
• Subjects: Adolescent; Bacterial diseases; Biological and medical sciences; Child; Child, Preschool; Decision Support Techniques; General aspects; Human bacterial diseases; Humans; Infectious diseases; Medical sciences; Pediatrics; Pharyngitis - diagnosis; Pharyngitis - microbiology; Physical Examination; Sensitivity and Specificity; Staphylococcal infections, streptococcal infections, pneumococcal infections; Streptococcal Infections - diagnosis; Streptococcus pyogenes; GAS; Likelihood ratio; Group A Streptococcal; LR; Human; Pediatrics; Systematic review; Angina; Infection; Streptococcaceae; Streptococcus β hémolytique; Symptomatology; Accuracy; Streptococcal infection; Bacteriosis; Bacteria; Micrococcales; ENT disease; Pharynx disease; Sign; Pharyngitis; Child
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2011.09.011

Objective To conduct a systematic review to determine whether clinical findings can be used to rule in or to rule out streptococcal pharyngitis in children. Study design Two authors independently searched MEDLINE and EMBASE. We included articles if they contained data on the accuracy of symptoms or signs of streptococcal pharyngitis, individually or combined into prediction rules, in children 3-18 years of age. Results Thirty-eight articles with data on individual symptoms and signs and 15 articles with data on prediction rules met all inclusion criteria. In children with sore throat, the presence of a scarlatiniform rash (likelihood ratio [LR], 3.91; 95% CI, 2.00-7.62), palatal petechiae (LR, 2.69; CI, 1.92-3.77), pharyngeal exudates (LR, 1.85; CI, 1.58-2.16), vomiting (LR, 1.79; CI, 1.58-2.16), and tender cervical nodes (LR, 1.72; CI, 1.54-1.93) were moderately useful in identifying those with streptococcal pharyngitis. Nevertheless, no individual symptoms or signs were effective in ruling in or ruling out streptococcal pharyngitis. Conclusions Symptoms and signs, either individually or combined into prediction rules, cannot be used to definitively diagnose or rule out streptococcal pharyngitis.